Objective of the seminar was to present for the common illness backache from the sports orthopaedic, traumatologic, sports medical, from the internal, from the pain therapeutic, neurosurgical and from the physiotherapeut

Objective of the seminar was to present for the common illness backache from the sports orthopaedic, traumatologic, sports medical, from the internal, from the pain therapeutic, neurosurgical and from the physiotherapeutic point of view new ways of looking at, based on physiologic, pathophysiologic knowledge, with relevance for prevention and therapy of the common problem backache. The low back pain as a result of the special quality of the "biped" in the time of hypomobilization and hyperalimentation - lumbar and cervical spine complaints (Udo Schreiber, MD, Frankfurt/Main): The back pain - especially the low back pain - is probably mostly caused by static disorders. In Germany the incidence of back pain within a lifetime is nearly 80 %. Dr. Schreiber explained that the anatomical length difference of the legs leads to a variety of pathological situations in the musculo-sceletal system. The pathologic changes - for instance transversal push to the ileosacral joint - mostly appear at the side of the longer leg with a scoliosis of the spinal column with increased pressure loads on the concave side of the scoliosis in the intervertebral disks and with typical blockings in different vertebral segments. Adequate diagnosis includes anamnesis and extensive clinical examination to recognize functional deficits instead of only imaging diagnostics. Useful therapies are - besides analgetic therapies, like manual therapy, matrix rhythm therapy, water-filtered infrared A (wIRA), ear acupuncture, magnetic field resonance therapy, micro current therapy, injection therapy - primarily the therapeutic preventive procedures stretching of shortened musculature and partial compensation of leg length differences. From an economical point of view static disorders cause immense indirect and direct disease costs, whereas the described adequate therapies are effective as well as economical. A holistic therapy concept with matrix rhythm therapy, hyperthermia, oxygen and anti-acidification - therapy of musculo-sceletal disorders (Bernhard Dickreiter, MD, Nordrach): The costs for the treatment of back pain burden the health insurance companies by diagnostic and therapy costs as well as the companies by sick-times increasingly in the past years. From the point of view of Dr. Dickreiter back school concepts of the past years have not shown the desired effects. Promising new aspects of handling of this clinical picture arise from the current results of the cellbiological basic researches and the new "matrix therapy concept" derived from it: The cause of the musculo-sceletal complaints in the sense of a myo-fascial, myo-ischemic-acidotic and myo-tendinitic pain syndrome is seen in the hardening of the musculature with an energy crisis at a cellular level. Within the new therapy concept there is not an abundance of treatments in the center of attention as before, but a modular concept in line with effectiveness, which affects the cellbiological processes especially at the extracellular matrix level. Essential parts of the concept are the matrix rhythm therapy as depth effective micro extension method, the local warming by water-filtered infrared A (wIRA) or the infrared whole body hyperthermia, the physical activity for the local improvement of oxygen supply, the oxygen therapy including hyperbaric oxygen therapy (HBO) and the orthomolecular substitution and "healthy" nutrition. Conservative, interventional and operative procedures from the point of view of the pain therapist and neurosurgeon: Place value with regard to an integrated medical treatment concept (Volker Ritzel, MD, Offenbach/Main): Backache can be treated successfully with an interdisciplinary therapy concept (general practitioner; orthopedics, neurosurgery, analgesic therapy, physiotherapy, psychotherapy) multimodal with use of conservative, interventional and operative procedures today. Special emphasis has to be laid on a sufficient therapy on time (among others protective, anticipating analgesia) to avoid the development of a pain memory with chronification of the pain and becoming independent from causes. Besides a drug based analgesic therapy in accordance with the WHO step scheme the transcutaneous electrical nerve stimulation (TENS), physiotherapy, psychotherapy, practicing procedures (progressive muscle relaxation by Jakobsen, autogenous training, Göttingen active back program GRAP), ergotherapy, acupuncture and balneotherapy belong to the conservative therapy possibilities. Further pain therapeutic, neurosurgical procedures are the therapeutic regional anesthesia, computed tomography controlled procedures, the percutaneous laser disk decompression, denervational procedures, the endoscopic sequestrectomy, the vertebroplasty, open operative procedures, the microsurgical decompression as well as implant procedures as the minimal-invasive cervical and lumbar spondylodesis. Today, outpatient procedures can be carried out in neurosurgical clinics in the context of a modern integrated care program. Back school for primary, secondary and tertiary prevention - lifestyle change, physiotherapy - in the age of integrated ambulatory care (Monika Kremer, Frankfurt am Main): Modern therapy strategies prefer - as far as possible - a conservative instead of an operative procedure, an active instead of a passive, a multimodal instead of a monotherapeutic procedure. Activities of motion and training therapy (e.g. extended ambulatory physiotherapy EAP as a complex therapy with the components physiotherapy, physical therapy and medical training therapy MTT) are important parts of modern back concepts. The working place conditions are taken into account particularly with an increasing integration of ergonomics training programs. The concept "preventive back school" covers the arrangement and application of effective everyday strategies to avoid great strain on the back to prevent the development of functional and degenerative diseases especially in the area of the spinal column including muscular dysbalances. An everyday behavior suitable for the back (e.g. correct lifting and carrying near the body) is included. Particularly effective are active training programs for the improvement of musculature and endurance in combination with behavior oriented training programs with the objective to improve well-being and quality of life. The concept of the Research and Prevention Center Cologne (FPZ), the Kieser-training, the Baunatal back concept (BRK) and the tergumed® back concept are explained. Frequently backache can be avoided by behaviors suitable for the back and by preventive and rehabilitative back training or a painless stable health status can be reached again in a rehabilitative sense after its occurrence. Keywords: back pain, anatomic length difference of the legs, pelvic obliquity, scoliosis, impaired statics, vertebral joint blockings, clinical examination, function deficits, imaging, deviations, pathologic changes, pathophysiology, therapy, multimodal therapy, manual therapy, water-filtered infrared A (wIRA), matrix rhythm therapy, ear acupuncture, magnetic field resonance therapy, micro current therapy, injection therapy, stretching of shortened musculature, hyperthermia, infrared whole body hyperthermia, oxygen, hyperbaric oxygen therapy (HBO), anti-acidification, myofascial, myo-ischemic-acidotic, myotendinitic pain syndrome, analgesic therapy, neurosurgery, physiotherapy, psychotherapy, conservative, interventional and operative procedures, transcutaneous electrical nerve stimulation (TENS), therapeutic regional anesthesia, computed tomography (CT) controlled procedures, percutaneous laser disk decompression, denervating procedures, endoscopic sequestrectomy, vertebroplasty, open operative procedures, microsurgical decompression, implant procedures, minimal invasive cervical and lumbar spondylodesis, outpatient procedures, neurosurgical clinics, integrated ambulatory care, preventive back school, primary, secondary, tertiary prevention, lifestyle change, motion/training therapeutic procedures, muscular dysbalances, behavior oriented training programs, quality of life, back training